metabolic tumor parameters complement clinicopathological factors in prognosticating advanced stage hodgkin lymphoma

Objective(s): advanced hodgkin lymphoma has a higher probability of relapse and recurrence. classical clinicopathological parameters including the international prognostic score (ips) have not been reliable in predicting prognosis or tailoring treatment.  since fdg pet/ct is the standard of care in staging hodgkin lymphoma, this study attempted to evaluate the clinical utility of baseline metabolic tumor parameters in a cohort of advanced hodgkin lymphoma (stage iii and iv).methods: histology-proven advanced hodgkin patients presenting to our institute between 2012-2016 and treated with chemo-radiotherapy (abvd / aevd) were followed up till 2019. quantitative pet/ct and clinicopathological parameters were used to estimate the event free survival (efs) in 100 patients. kaplan-meier method with log-rank test was used to compare the survival times of prognostic factors.results: at a median follow-up of 48.83 months (iqr:33.31-63.05 months), the five-year-efs was 81%. of the 100 patients, 16 had relapsed (16%) and none died at the last follow-up. on univariate analysis, among non-pet parameters bulky disease (p=0.03) and b-symptoms (p=0.04) were significant while among pet/ct parameters suvmax (p=0.001), suvmean (p=0.002), wbmtv2.5 (p<0.001), wbmtv41% (p<0.001), wbtlg2.5 (p<0.001) and wbtlg41% (p <0.001) predicted poorer efs.  5-year efs for patients with low wbmtv2.5 [<1038.3 cm3] was 89% and 35% for patients with high wbmtv2.5 [≥1038.3 cm3] (p <0.001). in a multivariate model, only wbmtv2.5 (p=0.03) independently predicted poorer efs.conclusion: pet-based metabolic parameter (wbmtv2.5) was able to prognosticate and complement the classical clinical prognostic factors in advanced hodgkin lymphoma. this parameter could have a surrogate value for prognosticating advanced hodgkin lymphoma. better prognostication at baseline translates to tailored or risk-modified treatment and hence higher survival.